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Clinical Toxicology

Iva Klobučar, Ines Potočnjak, Jelena Dumančić, Karlo Stemberger, Miriam Čupić, Tomislav Kokotović, Zdravka Kucijan, Vesna Degoricija
PURPOSE: To determine the demographic and social characteristics of acutely intoxicated patients in the emergency department (ED), intention of drug/chemical intake, main toxic agents, outcomes and time trends for all variables. METHODS: This prospective, observational study included acutely intoxicated patients treated in the ED of the University Hospital Centre Sisters of Charity, Zagreb, Croatia, during the years 2001, 2010 and 2015. The diagnosis was derived from patient's self-report, clinical observations and laboratory test results (quantitative test for serum ethanol levels and qualitative tests for drugs in urine)...
October 13, 2018: Clinical Toxicology
Bharath A Chhabria, Ashish Bhalla, Nusrat Shafiq, Susheel Kumar, Deba Prasad Dhibar, Navneet Sharma
INTRODUCTION: Organophosphate (OP) poisoning is an important public health concern in South-Asia especially in the farming population. Treatment of OP poisoning has remained unchanged since decades and case fatality is 10-40% despite best supportive care, anticholinergic agents and oximes. A new antidote is the need of the hour. Lipid emulsion being inexpensive, easily available and effective in management of other lipid soluble toxins may be a novel option. However, safety has not been established and efficacy is limited to animal studies and case reports in humans with OP poisoning...
October 11, 2018: Clinical Toxicology
Katharina Marquart, Julia Herbert, Niko Amend, Horst Thiermann, Franz Worek, Timo Wille
BACKGROUND: In a military or terrorist scenario, combination of organophosphorus compounds (OP) poisoning with physical trauma requiring surgical treatment and thus general anaesthesia are possible. Previous in vitro studies showed an altered potency of relevant anaesthetics during cholinergic crisis. Hence, it is not clear, which anaesthetics are suitable to achieve the necessary stage of surgical anaesthesia in OP poisoning. METHODS: In the present study, different anaesthetic regimens (ketamine-midazolam, propofol-fentanyl, thiopental-fentanyl), relevant in military emergency medicine, were examined in soman-poisoned rats...
October 11, 2018: Clinical Toxicology
Alexandre Nuzzo, Caroline Shaar-Chneker, Marianne Maillet, Bruno Mégarbane
No abstract text is available yet for this article.
October 11, 2018: Clinical Toxicology
Francesco Paolo Busardò, Alan Wayne Jones
INTRODUCTION: γ-Hydroxybutyric acid is an endogenous substance, a therapeutic agent, and a recreational drug of abuse. This psychoactive substance acts as a depressant of the central nervous system and is commonly encountered in clinical and forensic practice, including impaired drivers, poisoned patients, and drug-related intoxication deaths. OBJECTIVE: The aim of this review is to assist clinical and forensic practitioners with the interpretation of γ-hydroxybutyric acid concentrations in blood, urine, and alternative biological specimens from living and deceased persons...
October 11, 2018: Clinical Toxicology
Simon De Pralormo, Marion Brunet, Armelle Marquis, Chloé Bruneau, Gaël Le Roux, Marie Deguigne
INTRODUCTION: Most household and body soaps have an alkaline pH (9-12). In addition to their foaming effect, they irritate the skin. This study aims to review soap exposure reported to the Angers Poison Control Centre. METHOD: A retrospective study of accidental or deliberate oral exposure to solid soaps reported to the Angers Poison Control Centre between 1 January 2000 and 1 April 2015. Poisoning severity was reassessed for each case according to the Poisoning Severity Score (PSS)...
October 11, 2018: Clinical Toxicology
Robert S Hoffman, David N Juurlink, Marc Ghannoum, Thomas D Nolin, Valéry Lavergne, Sophie Gosselin
No abstract text is available yet for this article.
October 11, 2018: Clinical Toxicology
Tara B Hendry-Hofer, Alyssa E Witeof, Dennean S Lippner, Patrick C Ng, Sari B Mahon, Matthew Brenner, Gary A Rockwood, Vikhyat S Bebarta
BACKGROUND: Cyanide is a deadly compound used as a terrorist agent. Current FDA approved antidotes require intravenous administration, limiting their utility in a mass casualty scenario. Dimethyl trisulfide (DMTS), a sulfur-based molecule, binds cyanide converting it to the less toxic by-product thiocyanate. Studies evaluating efficacy in rodents have been performed, but a large, clinically relevant animal model has not been reported. OBJECTIVE: This study evaluates the efficacy of intramuscular DMTS on survival and clinical outcomes in a swine model of acute, severe cyanide toxicity...
October 11, 2018: Clinical Toxicology
Sanjay Vikrant, Ajay Jaryal, Dalip Gupta, Anupam Parashar
AIM: To study the epidemiology and outcome of acute kidney injury (AKI) caused by venomous animals. METHODS: A retrospective study of patients admitted at Indira Gandhi Medical College Hospital, Shimla, with AKI due to venomous animals over a period of 15 years (January 2003-December 2017). Medical records were evaluated for patient information on demographic factors, clinical characteristics, complications, and outcome. Outcomes of requirement for intensive care unit (ICU) support, treatment with dialysis, survival, and mortality were analyzed...
October 11, 2018: Clinical Toxicology
Eric J Lavonas, Charles J Gerardo
No abstract text is available yet for this article.
October 11, 2018: Clinical Toxicology
Eric P Brass, Randy I Burnham, Kate M Reynolds
BACKGROUND: Overdoses due to therapeutic misuse result when the maximum dose of a drug is exceeded while using it for its intended purpose, due to either intentionally exceeding the label dose, misunderstanding the label or use of more than one product with the same ingredient. Nonprescription acetaminophen-containing combination products have been hypothesized to be a risk for therapeutic misuse. This study assessed the contribution of nonprescription acetaminophen-containing products to Poison Center exposures and the time trend in these exposures since public attention was brought to their potential risks...
October 11, 2018: Clinical Toxicology
Lotte Christine Groth Hoegberg, Frank Refsgaard, Steen Hauge Pedersen, Mark Personne, Shahid Ullah, Georgios Panagiotidis, Tonny Studsgaard Petersen, Anita Annas
OBJECTIVE: Extended release (ER) tablets/capsules in massive ingestion overdoses are prone to form pharmacobezoars potentially increasing the risk of late-appearing toxic effects and prolonged symptoms. Oral activated charcoal is often sufficient to prevent drug absorption, but in a recent massive ingestion of highly toxic substances, prior orogastric lavage might be considered. The disintegration characteristics of ER preparations in overdose situations is valuable to understand if the time line and course of the intoxication might be prolonged, but information on these characteristics are unavailable...
October 11, 2018: Clinical Toxicology
Robert M Gifford, Umesh Chathuranga, Thomas Lamb, Vasundhara Verma, Md Abdus Sattar, Adrian Thompson, Sisira Siribaddana, Aniruddha Ghose, Shareen Forbes, Rebecca M Reynolds, Michael Eddleston
BACKGROUND: Ingestion of organophosphorus (OP) insecticides is associated with acute hyperglycaemia. We conducted a prospective study to determine whether glucose dysregulation on admission associated with ingestion of OP insecticides or other pesticides is sustained to hospital discharge or to 3-12 months later. METHODS: We recruited participants to two similar studies performed in parallel in Anuradhapura, Sri Lanka, and Chittagong, Bangladesh, following hospitalisation for OP insecticide, herbicide or other pesticide self-poisoning...
October 11, 2018: Clinical Toxicology
Michael J Moss, J Ashton Fisher, Tara A Kenny, Allison C Palmer, John A Thompson, Hannah Wolfer, Robert G Hendrickson
BACKGROUND: Salicylates are usually rapidly absorbed and quickly measurable in serum. An undetectable serum salicylate concentration ([ASA]) may occur early after ingestion and may be interpreted as evidence of non-exposure and not repeated. Although cases of delayed salicylate detection are reported rarely, the risk factors associated with this phenomenon are not known. RESEARCH QUESTION: What factors are associated with an early undetectable [ASA] in salicylate poisoning? METHODS: Records from a single regional poison center were searched from 2002 to 2016 for cases of salicylate toxicity treated with bicarbonate and [ASA] > 30 mg/dL...
October 11, 2018: Clinical Toxicology
Lucy M Bracken, Betty S H Chan, Nicholas A Buckley
CONTEXT: Recommended doses of digoxin-specific antibody fragments (digoxin-Fab) for treatment of acute digoxin poisoning are pharmacokinetically unsubstantiated and theoretically excessive. Physiologically based pharmacokinetic (PBPK) modelling creates clinical simulations which are closely related to physiological and pharmacokinetic behaviour. This paper details the formulation of a PBPK model of digoxin and explores its use as a simulation tool for acute digoxin toxicity and its management...
October 11, 2018: Clinical Toxicology
Adrienne Hughes, Robert G Hendrickson
INTRODUCTION: E-cigarettes are battery-powered electronic nicotine delivery systems that simulate smoking by vaporizing nicotine-containing solutions. Systematic published data on e-liquid toxicity and exposures are limited to case reports and retrospective studies. Prospectively-collected data on the type of exposure, symptomatology, duration of symptoms, and concentration/flavor of e-fluids has not been published. METHODS: This was a prospective observational study over a 42-month period (07/01/2014-12/31/2017)...
October 11, 2018: Clinical Toxicology
Moteb Khobrani, Yvonne Huckleberry, Keith J Boesen, Ahmed Aljabri, Mobarak Alharthi, Asad E Patanwala
CONTEXT: The administration of Crotalidae polyvalent immune Fab (FabAV) currently requires close observation, so patients can be monitored for hypersensitivity reactions. The objective of this study was to evaluate the occurrence of hypersensitivity reactions to FabAV. METHOD: This was a retrospective cohort study utilizing data from a statewide poison center database in the United States. Records of all patients envenomated by a rattlesnake and treated with FabAV between January 2002 and December 2014 were evaluated...
September 27, 2018: Clinical Toxicology
Philippe Hantson
BACKGROUND: Dilated cardiomyopathy is a frequent disease responsible for 40-50% of cases of heart failure. Idiopathic cardiomyopathy is a primary disorder often related to familial/genetic predisposition. Before the diagnosis of idiopathic cardiomyopathy is made, clinicians must not only rule out viral and immune causes, but also toxic causes such as drugs, environmental agents, illicit substances and natural toxins. OBJECTIVE: The objective of this review is to present recent data on the mechanisms underlying toxic cardiomyopathy...
September 27, 2018: Clinical Toxicology
Susan Smolinske, Robert S Hoffman, Eric Villeneuve, Lotte C G Hoegberg, Sophie Gosselin
OBJECTIVE: Although anecdotal reports suggest that intravenous lipid emulsion (ILE) therapy is effective in a large variety of overdoses, the few controlled human trials published to date yielded disappointing results. Because of potential publication biases, there are few reports concerning the failure of ILE. The primary aim of this study was to identify fatal poisoning cases in the American Association of Poison Control Centers (AAPCC) National Poison Data System (NPDS) in which ILE was administered...
September 27, 2018: Clinical Toxicology
Rittirak Othong, Suttisak Wattanasansomboon, Thanakorn Kruutsaha, Douglas Chesson, Sakda Arj-Ong Vallibhakara, Ziad Kazzi
INTRODUCTION: New QT correction formulae derived from large populations are available such as Rautaharju's [QTcRTH = QT * (120 + HR)/180] and Dmitrienko's [QTcDMT = QT/RR0.413 ]. These formulae were derived from 57,595 and 13,039 cases, respectively. Recently, a study has shown that they did not experience errors across a wide range of heart rates compared to others. OBJECTIVES: (1) To determine the best cut-off value of QTcRTH and QTcDMT as a predictor of torsade de pointes (TdP) and (2) to compare the sensitivity and specificity using the cut-off value of QTcRTH with those of the QTcBazett (QTcBZT), QTcFridericia (QTcFRD), and QT nomogram...
September 27, 2018: Clinical Toxicology
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